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tailored to each patient's personal profile, rather
than conventional goals from a fixed population's
normal values.19 Without non-invasive hemodynamic
monitors, individualization is much less feasible.
Most non-invasive systems require little set up, are
cost effective, and readily transferable into any
clinical setting. Hence, functional hemodynamic
monitoring based on individual dynamic cardiac
preload parameters could potentially play a role in
optimizing high-risk, critically ill surgical patients and
improve postoperative outcomes.
The final frontier is incorporation of non-invasive
monitoring devices into home health visits. Data
can be easily collected for remote interpretation
by clinicians or live-streamed to provide real-time
assessment. The CHAMPION trial was a large,
multicenter randomized study that used wireless
implantable hemodynamic devices (CardioMEMS,
St. Jude, Atlanta, GA) to remotely monitor intracardiac
and pulmonary artery pressures in patients with heart
failure.20 Clinicians were able to remotely monitor for
increases in cardiac filling pressures and significantly
decrease hospitalizations for acute decompensated
heart failure. Compared to traditional management
strategies, increased cardiac filling pressures were
detected weeks prior to the onset of symptoms.20
We sought to assess feasibility of remote
hemodynamic monitoring with non-invasive devices
in a similar cohort by conducting a pilot study with
80 home health visits to patients with NYHA 3 heart
failure with implanted CardioMEMS devices. We
compared hemodynamic measures from the noninvasive pulse contour device, Clearsight, to the
CardioMEMs invasive monitor. We demonstrated a
statistically significant positive correlation between
hemodynamic variables for both devices (rs=0.7,
p<0.019). Our study suggests that non-invasive
hemodynamic monitors can be used to augment
remote hemodynamic assessment and may
even curtail hospitalization, as early detection of
hemodynamic changes facilitates early therapeutic
intervention.

The COVID-19 pandemic has presented new
challenges for healthcare. Transitioning from inperson clinic visits to remote telemedicine has
hindered physical examination. The utility of noninvasive hemodynamic monitors is more significant
now than ever before. For high-risk patients,
remote monitoring potentially limits the risk of
COVID-19 exposure, and even patients who are not
technologically savvy can utilize these user-friendly
devices. Furthermore, remote monitoring reduces
travel burden and reliance on transport services for
those with limited mobility. This proactive approach
empowers patients, allowing them to be actively
involved in promoting optimal disease management.
Although smaller studies have demonstrated
that these innovative non-invasive hemodynamic
systems can improve patient outcomes, large-scale
randomized studies are needed to truly assess
the clinical impact of these devices. Validation
studies have been limited as the comparative gold
standard has yet to be established; some studies use
echocardiogram, while others use transpulmonary
thermodilution to measure intracardiac pressure
and CO. There are conflicting results about the
efficacy and precision of these tools in the clinical
setting, and further research is needed to assess
the accuracy and validity of these hemodynamic
monitoring systems in a broader cohort with differing
physiological conditions. Nonetheless, as noninvasive hemodynamic technology is refined, the use
of these non-invasive devices could transform the way
anesthesiologists direct hemodynamic management.
Acknowledgements: We would like to thank
Davinder Ramsingh, MD, for his guidance and
invaluable mentorship.

Annual Publication 2020

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Vital Times 2020

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